Screening For Congenital Heart Disease Research Articles

Prenatal ultrasound monitoring and diagnostic accuracy rates of fetal congenital heart disease: A meta-analysis.

Congenital heart disease (CHD) is the most common birth defect that is caused by genetic and acquired factors. Accurate prenatal diagnosis of congenital heart disease (CHD) can ensure proper delivery and in-time postpartum management, but the diagnostic rate is not clear. PubMed, CNKI, Web of Science, Wanfang, and VIP databases were searched for publications investigating CHD during prenatal ultrasound scans. Original studies with strict screening and diagnostic criteria were included. Fixed effect model or random effect model was used according to homogeneity statistical test. A total of 859 CHD cases were diagnosed by ultrasound, and 1394 cases were confirmed by induced labor autopsy or at birth. The heterogeneity of the analysis was 100% and the accuracy of CHD diagnosis using prenatal ultrasound was 76% (95%CI: 50.00%-102%). The diagnostic yield of fetal CHD screening using ultrasound alone is still not very high, which lower than the combined diagnostic yield of other studies. This suggests the need to combine other monitoring methods that do not harm fetal development. When economic conditions permit, the diagnosis of CHD can be recommended to use no less than two monitoring methods.

Characterization of Aortic Flow Patterns by High‐Frame‐Rate Blood Speckle Tracking Echocardiography in Children

Background Blood speckle tracking echocardiography allows for direct quantification of interventricular and aortic flow profiles, principally in children. Here, we sought to demonstrate the feasibility and reproducibility of blood speckle tracking echocardiography in the aortas of healthy children. Methods and Results One hundred healthy White children evaluated for the screening of congenital heart disease were prospectively enrolled. Echocardiographic examinations were performed using a Vivid E 95 ultrasound system, with blood speckle tracking from a focused and zoomed view of the aortic root and the ascending aorta. Vortex position, height (mm), width (mm), sphericity index, and area (cm2) were measured and indexed by body surface area. Median (interquartile range) age was 8.2 (5.6-11.0) years, median (interquartile range) weight was 28 (19-35) kg, and median (interquartile range) body surface area was 1.01 (0.79-1.16) m2. Vortices were visualized in only a single phase of the cardiac cycle in 25 subjects-14 (56.0%) were evident in early diastole and 11 (44.0%) in late systole. Vortices visualized in diastole had a mean area of 0.27±0.1 cm2/m2, while those in systole had a mean area of 0.34±0.12 cm2/m2. In a subset of 20 patients, inter- and intraobserver coefficient of variation and intraclass correlation coefficients were determined and showed good reproducibility. Conclusions We demonstrate feasibility and reproducibility of blood speckle tracking and identified vortical flow patterns in the aortic root and ascending aorta in healthy children. These data may serve as a baseline for evaluating aortic flow patterns in children with congenital and acquired heart disease.

Heart Disease Screening and False Hypoxemia in the Neonate

Background Screening for congenital heart diseases by pulse oximetry is used for the initial assessment of the neonate. Variants of hemoglobin F can compromise light absorbance, inducing erroneous results. Case report Two infants screened for congenital heart disease showed an asymptomatic low peripheral oxygen saturation. Arterial blood gases analysis revealed a normal arterial pressure of oxygen and oxygen saturation. More likely and/or severe causes of hypoxemia were ruled out. This “artifact” with SpO2-SaO2 dissociation, and after exclusion of other common etiologies of hypoxemia, raised the clinical suspicion of hemoglobinopathy. Hemoglobin molecular and genetic studies identified specific mutations in gamma chains from hemoglobin F, named hemoglobin F Sardinia. Conclusion Hemoglobin F variants may result in low peripheral oxygen saturation readings by pulse oximetry, explaining the discordance in the clinical appearance and low peripheral oxygen saturation readings.

Deep learning model for prenatal congenital heart disease (CHD) screening generalizes to the community setting and outperforms clinical detection.

Congenital heart defects (CHD) are still missed despite nearly universal prenatal ultrasound screening programs, which may result in severe morbidity or even death. Deep machine learning (DL) can automate image recognition from ultrasound. The aim of this study was to apply a previously developed DL model trained on images from a tertiary center, to fetal ultrasound images obtained during the second-trimester standard anomaly scan in a low-risk population. All pregnancies with isolated severe CHD in the Northwestern region of the Netherlands between 2015 and 2016 with available stored images were evaluated, as well as a sample of normal fetuses' examinations from the same region. We compared initial clinical diagnostic accuracy (made in real time), model accuracy, and performance of blinded human experts with access only to the stored images (like the model). We analyzed performance by study characteristics such as duration, quality (independently scored by study investigators), number of stored images, and availability of screening views. A total of 42 normal fetuses and 66 cases of isolated CHD at birth were analyzed. Of the abnormal cases, 31 were missed and 35 were detected at the time of the clinical anatomy scan (sensitivity 53 percent). Model sensitivity and specificity was 91 and 93 percent, respectively. Blinded human experts (n=3) achieved sensitivity and specificity of 55±10 percent (range 47-67 percent) and 71±13 percent (range 57-83 percent), respectively. There was a statistically significant difference in model correctness by expert-grader quality score (p=0.04). Abnormal cases included 19 lesions the model had not encountered in its training; the model's performance (15/19 correct) was not statistically significantly different on previously encountered vs. never before seen lesions (p=0.07). A previously trained DL algorithm out-performed human experts in detecting CHD in a cohort in which over 50 percent of CHD cases were initially missed clinically. Notably, the DL algorithm performed well on community-acquired images in a low-risk population, including lesions it had not been previously exposed to. Furthermore, when both the model and blinded human experts had access to stored images alone, the model outperformed expert humans. Together, these findings support the proposition that use of DL models can improve prenatal detection of CHD.

A Pseudo-Siamese Feature Fusion Generative Adversarial Network for Synthesizing High-Quality Fetal Four-Chamber Views.

Four-chamber (FC) views are the primary ultrasound(US) images that cardiologists diagnose whether the fetus has congenital heart disease (CHD) in prenatal diagnosis and screening. FC views intuitively depict the developmental morphology of the fetal heart. Early diagnosis of fetal CHD has always been the focus and difficulty of prenatal screening. Furthermore, deep learning technology has achieved great success in medical image analysis. Hence, applying deep learning technology in the early screening of fetal CHD helps improve diagnostic accuracy. However, the lack of large-scale and high-quality fetal FC views brings incredible difficulties to deep learning models or cardiologists. Hence, we propose a Pseudo-Siamese Feature Fusion Generative Adversarial Network (PSFFGAN), synthesizing high-quality fetal FC views using FC sketch images. In addition, we propose a novel Triplet Generative Adversarial Loss Function (TGALF), which optimizes PSFFGAN to fully extract the cardiac anatomical structure information provided by FC sketch images to synthesize the corresponding fetal FC views with speckle noises, artifacts, and other ultrasonic characteristics. The experimental results show that the fetal FC views synthesized by our proposed PSFFGAN have the best objective evaluation values: SSIM of 0.4627, MS-SSIM of 0.6224, and FID of 83.92, respectively. More importantly, two professional cardiologists evaluate healthy FC views and CHD FC views synthesized by our PSFFGAN, giving a subjective score that the average qualified rate is 82% and 79%, respectively, which further proves the effectiveness of the PSFFGAN.

Comparing Strategies for Critical Congenital Heart Disease Newborn Screening.

An extended newborn critical congenital heart disease (CCHD) screening program using oximetry has been implemented in Taipei, Taiwan since April 2014. This study was conducted to investigate the test accuracy and efficiency of this screening protocol. This study analyzed data from 30 birthing facilities representing 87.9% of live births in Taipei. Positive screening was defined as oxygen saturation <95% in either extremity or a preductal-postductal oxygen saturation difference of >3%. This study cohort was used to retrospectively estimate outcomes on the basis of different CCHD screening protocols. During the study period, 93 058 of 94 204 (98.8%) infants who had no prenatal suspicion were screened. The referral rate was 0.17% (156/93 058), and up to 90% of test-positive infants were referred within 48 hours of life. Forty-two CCHD cases without prenatal suspicion were detected and 97.6% were diagnosed within 72 hours of life. Of the screened newborns, 4 CCHD cases passed the screening. The false positive and false negative rates were 0.12% and 0.04%, respectively. In addition, applying our database to Spanish and updated American Academy of Pediatrics screening strategies led to more CCHD case detection. The Taipei protocol provided an efficient and effective screening referral system in a community setting. For optimal efficiency, we advocated the updated American Academy of Pediatrics algorithm/Spanish recommendation with a modification of immediate referral if oxygen saturation ≤90% in either extremity. The updated protocol would be practicable for nationwide screening in Taiwan and could also be applied to other regions with similar medical care systems.

Appropriate Technology for Screening, Diagnosis, and Evaluation of Neonatal Congenital Heart Disease in the Southernmost Region of China

Background: Early detection, diagnosis, and treatment of children with CHD has been the focus of research attention. Hainan is the southernmost underdeveloped province in China, where the technology of screening, diagnosis, and treatment for children with CHD has not been fully developed. Objectives: This study aimed to introduce and promote an appropriate technology system for screening, diagnosis, and evaluation of neonatal CHD. Methods: Two indicators, namely cardiac auscultation plus pulse oximetry (POX), were used by screening staff to screen live newborns within six to 72 hours after birth at all screening institutions in Hainan province from January 1, 2019, to December 31, 2021. Diagnosis procedure for the screened-positive newborns was performed in 31 certified medical institutions, and evaluation procedure for the newborns confirmed with CHD was performed in six certified medical institutions. Data about screening, diagnosis, evaluation, and treatment were obtained, uploaded, and managed online through a neonatal CHD screening information management net. Results: A total of 321447 live births were included in the CHD screening project, and an overall screening rate of 97.59% (321447/329387) was determined. According to our results, 8032 cases were screened-positive. A total of 1099 cases of CHD were confirmed, suggesting a CHD prevalence of 3.419 per 1000 live births. Atrial septal defect (ASD) was the most common CHD lesion, with a prevalence of 1.313 per 1000 live births. The sensitivity of cardiac auscultation, POX, and two indicators’ combination (i.e., cardiac auscultation plus POX) for CHD detection were 69.15%, 33.49%, and 91.90%, respectively; and the specificity of them were 98.36%, 99.43%, and 97.81%, respectively. The ratio of both positive in two indicators among the children with major (serious and critical) CHD at the initial screening was significantly higher than that of single positive in any indicator (χ2 = 59.455, P &lt; 0.001). All children with CHD were evaluated, out of who 154 children with major CHD were treated promptly. Only 15 cases of children with major CHD died, and the standardized mortality of children aged 0 - 1 years with CHD was 4.67/100,000. Conclusions: It was concluded that the combination of two indicators (i.e., cardiac auscultation plus POX) for CHD screening was reliable as well as non-invasive, simple, and easy to operate so that it was conducive for promotion. It was also found that introducing and promoting an appropriate technology for screening, diagnosis, and evaluation of neonatal CHD were extremely significant since they may have contributed to the timely diagnosing and treating children with CHD, especially those with major CHD.

Appropriate Technology for Screening, Diagnosis, and Evaluation of Neonatal Congenital Heart Disease in the Southernmost Region of China

Background: Early detection, diagnosis, and treatment of children with CHD has been the focus of research attention. Hainan is the southernmost underdeveloped province in China, where the technology of screening, diagnosis, and treatment for children with CHD has not been fully developed. Objectives: This study aimed to introduce and promote an appropriate technology system for screening, diagnosis, and evaluation of neonatal CHD. Methods: Two indicators, namely cardiac auscultation plus pulse oximetry (POX), were used by screening staff to screen live newborns within six to 72 hours after birth at all screening institutions in Hainan province from January 1, 2019, to December 31, 2021. Diagnosis procedure for the screened-positive newborns was performed in 31 certified medical institutions, and evaluation procedure for the newborns confirmed with CHD was performed in six certified medical institutions. Data about screening, diagnosis, evaluation, and treatment were obtained, uploaded, and managed online through a neonatal CHD screening information management net. Results: A total of 321447 live births were included in the CHD screening project, and an overall screening rate of 97.59% (321447/329387) was determined. According to our results, 8032 cases were screened-positive. A total of 1099 cases of CHD were confirmed, suggesting a CHD prevalence of 3.419 per 1000 live births. Atrial septal defect (ASD) was the most common CHD lesion, with a prevalence of 1.313 per 1000 live births. The sensitivity of cardiac auscultation, POX, and two indicators’ combination (i.e., cardiac auscultation plus POX) for CHD detection were 69.15%, 33.49%, and 91.90%, respectively; and the specificity of them were 98.36%, 99.43%, and 97.81%, respectively. The ratio of both positive in two indicators among the children with major (serious and critical) CHD at the initial screening was significantly higher than that of single positive in any indicator (χ2 = 59.455, P &lt; 0.001). All children with CHD were evaluated, out of who 154 children with major CHD were treated promptly. Only 15 cases of children with major CHD died, and the standardized mortality of children aged 0 - 1 years with CHD was 4.67/100,000. Conclusions: It was concluded that the combination of two indicators (i.e., cardiac auscultation plus POX) for CHD screening was reliable as well as non-invasive, simple, and easy to operate so that it was conducive for promotion. It was also found that introducing and promoting an appropriate technology for screening, diagnosis, and evaluation of neonatal CHD were extremely significant since they may have contributed to the timely diagnosing and treating children with CHD, especially those with major CHD.

Impact of Newborn Screening Programme for Congenital Heart Disease in Shanghai: a five-year observational study in 801,831 newborns

Newborn Screening Programme for Congenital Heart Disease (CHD) in Shanghai has been in operation for over 5 years, and its feasibility and effectiveness still lack a systematic and comprehensive evaluation. This study aimed to detail the implementation of the programme and evaluate its results, benefits, and reliability in clinical practice. This study was an observational study involving all newborns received CHD screening in Shanghai from 2017 to 2021. Pulse oximetry (POX) plus cardiac murmur auscultation (namely the dual-index method) was used for CHD screening in newborns aged 6-72h. Newborns who screened positive was recommended for echocardiography, and those diagnosed with CHD would be planned for further evaluation and intervention. Data were aggregated by birth year and district of birth. Results of neonatal CHD screening, diagnosis and treatment, and temporal trends of infant mortality rate (IMR) and the proportion of under-five mortality (U5M) attributed to CHD were analysed. A retrospective cohort study was also conducted to assess the reliability of the dual-index method in clinical practice. In total, 801,831 (99.48%) newborns were screened for CHD, 16,489 (2.06%) were screened positive, and 3541 (21.47%) of the screened-positive newborns were identified with CHD. Seven hundred and fifty-two patients with CHD received surgical or interventional treatment with a successful rate of 94.81%. The period from 2015 to 2021 witnessed an approximately twofold decrease in IMR from 4.58‰ to 2.30‰, and a downtrend in the proportion of U5M attributed to CHD from 25.93% to 16.61%. High sensitivity and specificity of the dual-index method in clinical practice were observed for both critical (100.00% and 97.72%) and major CHD (98.47% and 97.76%). Newborn screening programme for CHD has been well implemented in Shanghai, and this programme is a successful public health intervention to reduce infant death. Our study provides encouraging evidence and experience for implementing newborn screening programme for CHD nationwide in China. This study was supported by the National Key Research and Development Programme of China (2021YFC2701004 and 2016YFC1000506), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-002), and Three-Year Planning for Strengthening the Construction of Public Health System in Shanghai (No. GWIV-24).

Congenital heart disease screening program in elementary schools: a research-based policy

Congenital heart disease screening program in elementary schools: a research-based policy

Application of Artificial Intelligence-Based Auxiliary Diagnosis in Congenital Heart Disease Screening.

To evaluate the application value of artificial intelligence-based auxiliary diagnosis for congenital heart disease. From May 2017 to December 2019, 1892 cases of congenital heart disease heart sounds were collected for learning- and memory-assisted diagnosis. The diagnosis rate and classification recognition were verified in 326 congenital heart disease cases. Auscultation and artificial intelligence-assisted diagnosis were used in 518 258 congenital heart disease screenings, and the detection accuracies of congenital heart disease and pulmonary hypertension were compared. Female sex and age > 14 years were predominant in atrial septal defect (P <.001) compared with ventricular septal defect/patent ductus arteriosus cases. Family history was more prominent in patent ductus arteriosus patients (P <.001). Compared with no pulmonary arterial hypertension, a male predominance was seen in cases of congenital heart disease-pulmonary arterial hypertension (P <.001), and age was significantly associated with pulmonary arterial hypertension (P =.008). A high prevalence of extracardiac anomalies was found in the pulmonary arterial hypertension group. A total of 326 patients were examined by artificial intelligence. The detection rate of atrial septal defect was 73.8%, which was different from that of auscultation (P =.008). The detection rate of ventricular septal defect was 78.8, and the detection rate of patent ductus arte-riosus was 88.9%. A total of 518 258 people from 82 towns and 1220 schools were screened including 15 453 suspected and 3930 (7.58%) confirmed cases. The detection accuracy of artificial intelligence in ventricular septal defect (P =.007) and patent ductus arteriosus (P =.021) classification was higher than that of auscultation. For normal cases, the recurrent neural network had a high accuracy of 97.77% in congenital heart disease-pulmonary arterial hypertension diagnosis (P =.032). Artificial intelligence-based diagnosis is an effective assistance method for congenital heart disease screening.

The role of first-trimester single arterial vessel sign instead of a V-sign at the level of the three-vessel and tracheal view in screening for congenital heart diseases

The role of first-trimester single arterial vessel sign instead of a V-sign at the level of the three-vessel and tracheal view in screening for congenital heart diseases

Maternal acceptability of screening for congenital heart diseases.

Maternal acceptability of screening for congenital heart diseases.

Performance of Pulse Oximetry in Screening of Critical congenital Heart Diseases: Meta-analysis of meta-analytic studies and systematic review.

Performance of Pulse Oximetry in Screening of Critical congenital Heart Diseases: Meta-analysis of meta-analytic studies and systematic review.

Revisiting the role of electrocardiography for screening of congenital heart disease in young adults

Introduction: Congenital heart disease (CHD) is the most prevalent congenital disability found in newborns. Many cases remain unknown until complications occur, usually in young adults. Transthoracic and Doppler echocardiography are modalities of choice for CHD detection, but these are limited in Indonesia. Electrocardiography (ECG) is a widely available and low-cost test. This study investigated the role of ECG as a screening modality for CHD. Methods: A cross-sectional study was held at Atma Jaya School of Medicine and Health Science from August to November 2019. Participants were students aged 18 years old or more. Exclusion criteria was previously detected for CHD. Data were collected through history taking, anthropometrics, blood pressure measurement, and 12 leads ECG. ECG results were interpreted independently by two cardiologists to minimize observer bias. Results: A total of 193 students, 78 male and 115 female, participated. The mean age was 19.22±1.85 years. ECG abnormalities were discovered in 57 (29.5%) participants:15 with crochetage sign, 13 right axis deviation, three left axis deviation, nine right ventricle hypertrophy, and nine left ventricle hypertrophy, six left bundle branch block, and two defective T wave. Further evaluation was done with echocardiography in 20 participants, which resulted in one participant having mitral valve prolapsed (MVP). Conclusion: ECG could detect the characteristic patterns suggestive of CHD, but ECG alone is insufficient to confirm cardiac structural abnormalities.

Current Postlaunch Implementation of State Mandates of Newborn Screening for Critical Congenital Heart Disease by Pulse Oximetry in U.S. States and Hospitals.

Our objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics. Between March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements. Responses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO2 as an immediate failed screen and 31% responded that an infant with SpO2 of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = -1.23 p = 0.01) and early adoption by states (beta = -1.01, p < 0.01). When presented with SpO2 screening values on a questionnaire, a low percentage of nurse supervisors selected responses that demonstrated adherence to nationally endorsed protocols for CCHD screening. Most notably, almost one-third of respondents did not recognize ≤90% SpO2 as a failed screen that requires immediate physician follow-up. In addition, states without reporting mandates and early adopter states were associated with low policy consistency. Implementing state reporting requirements might increase policy consistency, but some inconsistency may be the result of unique protocols in early adopter states that differ from nationally endorsed protocols. · Low adherence to nationally endorsed protocols.. · Inconsistent physician follow-up to hypoxia.. · Reporting improved consistency with national policy..

Abstract 12317: Improving Prenatal Detection of Heart Disease Scalable Composite Analysis of Six Fetal Cardiac Biometrics

While prenatal congenital heart disease (CHD) screening has improved, accuracy remains as low as 30 percent. Standard fetal biometrics—cardiac axis (CA), cardiothoracic ratio (CTR), RV fractional area change (FAC), LV FAC, RA:LA area ratio, RV:LV area ratio—are available from screening imaging and can each aid in CHD screening, but can be cumbersome to measure. Combinations of biometrics may offer further utility but are challenging to integrate at the point of care. We tested whether using these biometrics in combination has utility in CHD screening (normal vs. abnormal). Further, we tested whether automatically predicted biometrics could function similarly to manually-labeled biometrics for this purpose. We included 105 fetal echocardiograms (20 normal, 85 abnormal across 12 different CHD lesions). We manually calculated the six biometrics above, performed dimensionality reduction using principal component analysis, and then clustered the resulting data by K-means. A previously developed deep learning model (Arnaout et al Nature 2021) was also used to automatically predict biometrics for normal, tetralogy of Fallot, and hypoplastic left heart syndrome hearts and plotted on the above cluster map. Optimal number of clusters was four, with RV:LV ratio and CTR as the most important features distinguishing clusters. Cluster 1 was predominantly normal hearts with cluster 2-4 largely abnormal hearts (Figure 1). The sensitivity and specificity for predicting abnormal hearts (e.g. CHD) was 86% and 75%, respectively. Model-predicted biometrics landed in the same clusters as the manually labeled lesions (Figure 1). To our knowledge, this is the first use of clustering to provide visualization of multiple fetal cardiac biometrics at once and reveal diagnostic utility. Once tested in screening ultrasounds on a larger scale, clustering of automated biometrics may be clinically useful at the screening point of care to augment scalable population-based screening.

Deep Learning for Improving the Effectiveness of Routine Prenatal Screening for Major Congenital Heart Diseases.

Early prenatal screening with an ultrasound (US) can significantly lower newborn mortality caused by congenital heart diseases (CHDs). However, the need for expertise in fetal cardiologists and the high volume of screening cases limit the practically achievable detection rates. Hence, automated prenatal screening to support clinicians is desirable. This paper presents and analyses potential deep learning (DL) techniques to diagnose CHDs in fetal USs. Four convolutional neural network architectures were compared to select the best classifier with satisfactory results. Hence, dense convolutional network (DenseNet) 201 architecture was selected for the classification of seven CHDs, such as ventricular septal defect, atrial septal defect, atrioventricular septal defect, Ebstein's anomaly, tetralogy of Fallot, transposition of great arteries, hypoplastic left heart syndrome, and a normal control. The sensitivity, specificity, and accuracy of the DenseNet201 model were 100%, 100%, and 100%, respectively, for the intra-patient scenario and 99%, 97%, and 98%, respectively, for the inter-patient scenario. We used the intra-patient DL prediction model to validate our proposed model against the prediction results of three expert fetal cardiologists. The proposed model produces a satisfactory result, which means that our model can support expert fetal cardiologists to interpret the decision to improve CHD diagnostics. This work represents a step toward the goal of assisting front-line sonographers with CHD diagnoses at the population level.

Paediatric heart failure in Uyo: A retrospective analysis

Background/Aim: Paediatric heart failure is a condition that continues to present challenges in management in our environment especially in its treatment and outcomes hence the aim of this study.Materials and Methods: A retrospective analysis of the case notes of all children who were diagnosed and managed for heart failure from January 2019 – October 2021 was undertaken. Data obtained included age, sex, presenting features, primary diagnosis, treatment modalities, duration ofhospital stay and outcomes.Results: A total of 2226 children were admitted over the study period with 67 children diagnosed with heart failure giving a prevalence rate of 3% although only 47 case notes could be retrieved giving a case retrieval rate of 70%. There were 26 (55.3%) males and 21 (44.7%) females (M:F ratio1.2: 1). Mean age of patients was 32.6 months (±52.23) with 28 (59.6%) of them being infants. Bronchopneumonia was the commonest cause of heart failure 31(65.9%) either singly or in combination with acyanotic congenital heart disease followed by severe anaemia in 14 (29.8%). Average duration of hospital stay was 6.9days (±5.08) and average cost of admission was N13,266. Twenty-three patients were discharged (48.9%), while 10 (21.3%) left against medical advice, 2 absconded (4.3%) while 12 (25.3%) died.Conclusion: Heart failure remains an important cause of morbidity and mortality in children in our environment arising from largely preventable causes. Urgent steps such as patient care giver education, immunization and screening for congenital heart disease are needed to reduce its effect on children in our environment.

Clinical Screening of Congenital Heart Disease in Neonates: a Literature Review on Five Studies

Background: Diagnosing Congenital Heart Disease (CHD), particularly critical CHD in newborns, could be difficult but crucial, since the field of congenital heart surgery has shifted from initial palliation followed by final correction at a later age to stressing early repair even in the youngest individuals. Although echocardiography remains the gold standard for diagnosing CHD, simple clinical examination may be helpful in screening neonates who require further investigation and treatment. In this study, we searched and reviewed the literature on clinical screening for CHD using a simple, affordable tool that is readily available in primary health care facilities, to prove that early simple clinical examination would help physician to screen for asymptomatic CHD.Methods: We searched articles on google scholars that discuss clinical screening of CHD in neonates. Inclusion criteria is articles published within five years and exclusion criteria is articles published older than five years.Results: We found five articles eligible and pick consecutively. We found that pulse oximetry sensitivity and specificity ranged from 21.54%-77.3% and 82.65%-99.9%, respectively. Cardiac auscultation with murmur of grade ≥2 as count as positive, having high range of sensitivity and specificity, with sensitivity ranged from 17.3%-89.58% and specificity ranged from 47.36%-99.69%. When pulse oximetry and cardiac auscultation combined, three studies found that the sensitivity and specificity increased dramatically, 89.9%-95.5%, 94.7%-99.37%, respectively. Conclusion: Both cardiac auscultation and pulse oximetry was an easy, feasible method with readily available basic tools at all hospital with acceptable sensitivity and specificity to screening CHD before suspected neonates undergo echocardiography, therefore making CHD diagnosed more effective and efficient.